Edwin A. Burgstaler MT, HP (ASCP) Jeffrey L. Winters MD. ASFA 2017 Annual Meeting May 5, MFMER slide-1

Transcription

1 Comparison of Hematopoietic Progenitor Cell (HPC) Collection Using the Spectra Optia Continuous Mononuculear Cell (CMNC) Collections with a 26:1 Anticoagulant Ratio Versus an Anticoagulant ing Technique Edwin A. Burgstaler MT, HP (ASCP) Jeffrey L. Winters MD. ASFA 217 Annual Meeting May 5, MFMER slide-1

2 Conflict of Interest Mayo Clinic received consulting fees from Fresenius Kabi 216 MFMER slide-2

3 216 MFMER slide-3

4 Background Our apheresis center is concerned about excess fluid infusion and citrate toxicity during HPC collections Some patients (especially with amyloidosis) have problems with excess fluid infusion We treat citrate toxicity as it occurs, rather than prophylactic infusion of calcium We routinely use a heparin/acd-a anticoagulant and 26:1 AC ratio We previously reported a 2% rate of conversion to straight ACD-A using the Optia CMNC 216 MFMER slide-4

5 Purpose Using a high inlet flow technique, we wanted to compare ratio ramping (RR) and increased collect rates to an AC ratio of 26:1 in regard to: CD34+ cell yields and collection efficiencies CD34+ cell collection rates Lymphocyte yields and collection efficiencies Lymphocyte/monocyte ratios MNC yields and collection efficiencies Product volume Cross cellular content of granulocytes, RBC, and platelets 216 MFMER slide-5

6 Suggested Changes Use a gradual increase in AC ratio [ratio ramping (RR)] to properly anticoagulate early in the collection If heavy PLT clumping occurs, drop the AC ratios In patients/donors with high WBC counts, increase the collect rate 216 MFMER slide-6

7 Platelet Clumping on Optia CMNC (1) 216 MFMER slide-7

8 Platelet Clumping on Optia CMNC (2) 216 MFMER slide-8

9 Materials and Methods Retrospective review of 63 RR collections and 34 AC-26:1 3 machines, software 11. Maximum flow rates of 85 ml/min, initially Endpoint was 5 hr. Vendor recommendations were used except AC AC-26 Anticoagulant Started 26:1 ratio 1, units heparin in 1, ml ACD-A 3 ml in collection bag When needed: ACD-A, 1:1 ratio 216 MFMER slide-9

10 Materials and Methods (cont-1) ing Anticoagulant Started 1:1 ratio for 15 min 2:1 ratio for 15 min 26:1 ratio for remainder, if no extensive PLT clumps When needed: ACD-A, 1:1 ratio or less if needed Calcium given IV, only with symptoms PLT count drop was measured the next day RBC content measured by Sysmex counter 22 AC-26 collections used Sysmex 216 MFMER slide-1

11 Suggested Collect Rates Pre WBC Count (x1 9 /L) WB Flow Rate ml/min Collect Rate (ml/min) MFMER slide-11

12 Materials and Methods (cont-2) Collect rates- : 1. ml/min RR: 1. or ml/min (N=16) Procedure time does not include Rinseback Avg. Inlet Rate= Inlet processed/procedure time CE 2 = yield in product/ (pre count x [inlet AC] x 1) Stats: Mann-Whitney test, <.5 considered significant 216 MFMER slide-12

13 Preprocedure Blood Counts WBC (x1 9 /L) Significant MNC (x1 9 /L) Lymphocytes (x1 9 /L) Lymphocyte/Monocyte Ratio.8.73 Hematocrit (%) Platelets (x1 9 /L) MFMER slide-13

14 Procedure Parameters Average Inlet Rate (ml/min) Whole Blood Processed ( L) AC to patient (ml) 1,18 1,15 Fluid Balance (ml) Procedure Time (min) 3 3 Product Volume (ml) Procedures converted to ACD-A 8 (24%) 16 (25%) Procedures w/ac Ratio to 2:1 9 (26%) 8 (13%) 216 MFMER slide-14

15 CD34+ Cell Yield Medians x Not Significant 216 MFMER slide-15

16 CD34+ Cell Yield Medians X1 6 /Kg Not Significant 216 MFMER slide-16

17 CD34+ Collection Rate (X 1 6 /L) Medians X 1 6 /L Not Significant 216 MFMER slide-17

18 CD34+ Collection Rate (X 1 6 /Min) Medians X 1 6 /Min Not Significant 216 MFMER slide-18

19 Lymphocyte Yield Medians.5.4 X 1 9 /Kg Not Significant 216 MFMER slide-19

20 Lymphocyte Collection Efficiency (CE2) Medians % Not Significant 216 MFMER slide-2

21 Lymphocyte/ Monocyte Ratio Medians L/M Not Significant 216 MFMER slide-21

22 MNC Collection Efficiency (CE2) Medians % Not Significant 216 MFMER slide-22

23 WBC Yield Medians x Not Significant 216 MFMER slide-23

24 Granulocyte Differential Medians % Not Significant 216 MFMER slide-24

25 Granulocyte Yield Medians 5 4 x Not Significant 216 MFMER slide-25

26 Platelet Yield Medians x Not Significant MFMER slide-26

27 Platelet Collection Efficiency (CE2) Medians % Not Significant 216 MFMER slide-27

28 24 Hour Platelet Count Drop Medians % Not Significant N=18 N= MFMER slide-28

29 Red Blood Cell Yield Medians 3 ml Not Significant 216 MFMER slide-29

30 Calcium Doses Means Doses/Collection Not Significant MFMER slide-3

31 Citrate Reactions Percent of Total Collections 1 P e r c e n t MFMER slide-31

32 Conclusions Compared to, ing w/ increased collect rate had: A higher incidence of citrate reactions No significant differences in CD34+ cell and lymphocyte yields Fluid balance and product volume Cross cellular content of RBC, PLT, or Granulocytes Conversions to Straight ACD-A Doses of calcium gluconate per collection A trending to lower granulocyte content Less collections required drop to 2:1 AC ratio It was basically equivalent 216 MFMER slide-32